Provider Demographics
NPI:1952530487
Name:VELAZQUEZ-CANCEL, MARCIAL (MT)
Entity type:Individual
Prefix:
First Name:MARCIAL
Middle Name:
Last Name:VELAZQUEZ-CANCEL
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 NW 23RD TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6246
Mailing Address - Country:US
Mailing Address - Phone:352-562-4496
Mailing Address - Fax:
Practice Address - Street 1:4816 NW 23RD TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6246
Practice Address - Country:US
Practice Address - Phone:352-562-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSU38805246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist